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For us the women, the womb is not just another “organ”, but it is the symbol of fertility, sexuality and an integral part of our female identity.
So we have to treat the uterus, as gynecologists, with respect and make every effort to preserve it, exhausting any other therapeutic potential.
By hysterectomy we mean the removal of the uterus surgically.
After hysterectomy, the woman can no longer be pregnant.
What is removed during hysterectomy?
When the entire uterus (and cervix) is removed, the operation is called total hysterectomy.
Removing only the uterus means that although the woman no longer have menstruation, her hormonal cycle continues to exist as before the hysterectomy. So it does not have the unpleasant effects of climacteric.
If we remove with the uterus the fallopian tubes and the ovaries we are referring to total hysterectomy and bilateral salpingectomy-oophorectomy.
Removing the ovaries into a young woman means she will suddenly get into menopause.
Estrogen deficiency accelerates osteoporosis, atrophy of the vagina and dry skin of the genitalia.
It is often accompanied by hot flashes, irritation and psychological changes.
In other words, ovaries should be removed only when there is serious evidence, or if the woman is already in menopause.
If the gynecologist removes only the uterine body (the upper part of the uterus) and the cervix remains, then the surgery is called supracervial or subtotal hysterectomy.
What are the indications?
Only a small proportion of hysterectomies is due to malignancy:
- Of the endometrium
- Of the cervix
- Ovarian
- Precancerous cervical lesions that persist after the treatments
In most cases the uterus is removed for benign conditions:
- Uterine fibroids
- Heavy Dysfunctional Metrorrhagia (uterine bleeding)
- Chronic pelvic pain
- Serious adenomyosis or endometriosis
- Prolapsed uterus
For us the women, the womb is not just another “organ”, but it is the symbol of fertility, sexuality and an integral part of our female identity.
So we have to treat the uterus, as gynecologists, with respect and make every effort to preserve it, exhausting any other therapeutic potential.
What are the surgical techniques for hysterectomy?
The method that will be selected by the gynecologist will depend on your overall health, the age, the reason for the hysterectomy
It is rare instance for the surgeon to start the hysterectomy by a method and then change the approach if they find other existing complications.
1.
Abdominal hysterectomy
It is done through a transversal incision in the abdomen (such as the caesarean section).
It can be done with an epidural, general or a combination of the two types of anesthesia.
Following an abdominal hysterectomy, the woman will usually spend 3 days in the hospital.
2.
Vaginal hysterectomy
It occurs when there is a prolapse of the uterus out of the vagina, which is removed through the vagina.
The patient will usually spend three to five days in the hospital.
3.
Laparoscopic hysterectomy
The surgeon makes usually four tiny incisions in your abdomen and performs surgery with a laparoscope (a thin and flexible instrument with a lighted camera).
It can also be combined with vaginal hysterectomy (laparoscopic-assisted vaginal hysterectomy).
This type of surgery is:
less painful than abdominal hysterectomy
has a lower risk of infection
faster recovery.
Returning home will usually be the next day.
4.
Robot-assisted laparoscopic hysterectomy
What postoperative side effects might occur?
- There may be moderate pain, but you will easily manage it with painkillers.
- As with most major surgical procedures, a possible complication is thrombosis ( blood clots).
You will be asked to stand up and walk after surgery to facilitate circulation on your feet.
The cardiologist (who will examine you before operation), may ask for post-operative antithrombotic treatment.
- Intestinal motility disorders for a few days. They feel intestinal colic.
- It can be difficult to empty completely the bladder for a few days after hysterectomy.
How and when will the patient recover?
For 6-8 weeks after surgery:
- Rest
- Avoid lifting weights
- Stop heavy and moderate exercise
On the contrary, light exercise, like small daily walks, will improve your circulation and help you regain your strength.
- Avoid sexual intercourse.
- Avoid intravaginal washes and tampons
Abstain from work for one to four weeks.
Call your gynecologist if you experience any signs of infection such as fever, nausea or vomiting.
When are women undergoing hysterectomy doing a Pap smear test?
- When the type of their surgery was a subtotal hysterectomy.
- When hysterectomy was performed for a gynecological cancer.
- When HPV lesions were known.
In those cases where there has been total hysterectomy for benign disease and no history of HPV lesions, cytological control of the vagina is not recommended.
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